It is not easy to die in India.

The government has posted a draft of Medical Treatment of Terminally-Ill Patients Bill on its website for feedback from the public. This bill seeks to provide guidelines for terminally ill patients to be allowed to die by withholding treatment, what is known as passive euthanasia. Unfortunately, as with everything in India, the entire debate will be hijacked by those who scream the loudest because they are totally convinced in the infallibility of their opinions, presided over by those who have awarded themselves god like status, so that we, the people, will be ignored, as is usual. Already several provisions in the bill are causing controversy. The youngest age at which a patient will be allowed to refuse treatment is 16 years, which is enraging activists, who point out that you cannot get a driving license or get married before the age of 18 years, so how can you choose to die. Doctors will have to decide whether the patient is mentally competent to give such consent, but we know doctors will be under enormous pressure from hospital administration to keep a patient alive as long as possible so that the final bill can be increased. If the patient is incapable of providing consent the family may approach the High Court for permission to withdraw treatment, which means they will be easy prey for lawyers, who will not hesitate to gouge as much out of them as possible. What about a person who is in a persistent vegetative state and needs to be fed and cleaned without the need for life support? Should food and water be withdrawn so that the person dies of hunger and thirst? In which case does it become active euthanasia instead of a passive one? These questions arise because of the case of Aruna Shanbaug who was kept alive for 42 years by the caring dedication of the wonderful nurses at KEM Hospital in Mumbai, while interfering busybodies wanted to force her death by stopping all nutrition. Fortunately the nurses won the case and looked after her another 4 years. The most important point in end of life care is to provide adequate pain relief along with sympathetic nursing. Adequate pain relief means drugs derived from opium, usually morphine. A morphine infusion is given continuously and patients have the option of taking a bolus anytime they feel pain. And therein lies the problem. In India there is great sympathy for criminals so that laws are passed to punish the innocent. To stop addiction to drugs laws have been made so stringent that chemists do not sell opium derivatives. They will go bankrupt bribing government inspectors. In Delhi it is virtually impossible to find anti-histamine injections, such as pheniramine. These drugs have been around for over 50 years and are excellent in treating insect stings, vertigo and other sudden allergic reactions. Thus the debate about euthanasia is useless without adequate drug support. Just noise.